Psychological distress and unmet supportive care needs in melanoma-survivors and high-risk patients for melanoma: A Swiss cross-sectional study

Abstract Background Many melanoma patients experience worry, anxiety, and distress. Screening for psychological distress can facilitate early identification and management. However, little is known about such distress in melanoma survivors (MS) and patients at high risk for melanoma (HRM). Objectives The primary outcome was to assess the melanoma-related worry in MS and HRM patients. Additionally, a secondary outcome was to determine the optimal Distress Thermometer (DT) cut-off for identifying those needing psycho-oncological support. Methods We prospectively collected the distress-related patient-reported outcomes at the Department of Dermatology of the University Hospital in Basel, Switzerland, between 01/2021 and 01/2024. Validated questionnaires including the DT, Melanoma Worry Scale (MWS), Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7) were used to assess the primary outcome. For the secondary outcome, receiver operating characteristic (ROC) analysis were used to estimate the optimal DT cut-off. Results The study population comprised 430 individuals, including 175 (41%) MS and 255 (59%) HRM patients. Worry about getting a primary or subsequent melanoma was more prominent in MS with 26% compared to 16% of HRM patients. HRM patients had less melanoma worry compared to MS, with an odds ratio (OR) of 0.56 (95% CI: 0.34-0.93). Melanoma worry predictors included being divorced (OR:3.08, 95% CI:1.28-7.38) and younger (OR:0.97, 95% CI:0.95–0.99). HRM patients showed significant higher distress (median DT:4, interquartile (IQT):2,6) compared to MS (DT:2, IQT:1,5) (p-value<0.001). ROC analysis estimated DT of 3 as the optimal cut-off for MS (area under the curve [AUC]: 0.82, true positive rate [TPR]:0.95, false positive rate [FPR]:0.38), whereas DT of 6 was optimal in HRM (AUC: 0.77, TPR: 0.70, FPR: 0.22). Conclusions While MS exhibit greater disease-specific worry, HRM show increased general distress, underscoring distinct psycho-oncological needs. Adopting tailored DT cut-offs (≥3 for MS, ≥6 for HRM) may improve the detection of clinically relevant distress in these subgroups. Importantly, however, interest in psychological support was observed across all DT scores, indicating the need for flexible, patient-centred approaches. These findings highlight the unmet need for psychosocial care in both MS and HRM populations and could aid dermatologists to screen patients in future practice regularly.